tbuckley/cabot-search huggingface dataset:
Abstract 10015: Predictors of Primary Non-Adherence in Patients With Nonvalvular Atrial Fibrillation Prescribed Oral Anticoagulants in the US
Authors: Dionne M Hines, Victoria Divino, Lin Xie, David W Hood, Mitch DeKoven, Wanjiku Kariuki, Griffith Bell, Cristina Russ, Dong Cheng, Matthew Cato, Nipun Atreja, Inmaculada Hernandez
Journal: Circulation (2022)

Introduction: Primary non-adherence (PMN) is defined as the failure to fill an initial prescription for a medication or an appropriate alternative. This study assessed the rates and predictors of PMN among patients with non-valvular atrial fibrillation (NVAF) who were newly prescribed an oral anticoagulant (OAC). Methods: A retrospective database analysis of linked claims and electronic health record data was conducted using the Optum ® Market Clarity Dataset. Adult NVAF patients with a first written prescription for an OAC (apixaban, rivaroxaban, dabigatran, or warfarin) from 1/2016-6/2019 were identified (date of first prescription = index date). Patients had a 1-year pre-index period to describe baseline characteristics and a 6-month post-index period to assess rates of PMN, defined as having a written OAC prescription but not having a paid claim for any OAC within 30 days following the index date. Sensitivity analyses explored 60-, 90- and 180-day PMN thresholds. Logistic regression models were used to examine predictors of PMN. Results: The study sample comprised 20,393 patients (mean [SD] age 70.5 [11.3], 59.3% male, 90.0% Caucasian, 53.9% with Medicare only, 30.9% Commercial only, 54.5% in the Midwest). Apixaban (55.4%) was the most commonly prescribed OAC. The overall OAC 30-day PMN rate was 28.4%. Compared to warfarin, direct oral anticoagulants were associated with significantly higher odds of PMN (Figure 1). A CHA2DS2-VASc score of ≥3, Commercial insurance, and African American race were also associated with higher odds of PMN. Sensitivity analyses revealed decreasing PMN over time with a 180-day PMN rate of 17.0%. Conclusions: More than a quarter of patients experienced PMN within 30 days of an initial written OAC prescription; however, this rate decreases over a 180-day period, suggesting a delay in fills. Understanding the factors associated with no fills or delayed fills is warranted to guide interventions for improving OAC treatment rates in NVAF.
Abstract 10920: Efficacy of Cilostazol After Endovascular Therapy for Peripheral Artery Disease: A Meta-Analysis
Authors: Darlene Pearl Saballo, Marc Jusenn Yumena, Lea Arceli Gonzales
Journal: Circulation (2022)

Introduction. Endovascular therapies (EVT) for peripheral arterial disease (PAD) have been useful in improving quality of life outcomes; however, rates of restenosis after EVT remain high and lead to worse clinical outcomes. Use of cilostazol with antiplatelet therapy following EVT has been shown to improve clinical outcomes, although its role remains debatable. This meta-analysis aims to examine the clinical outcome of cilostazol use post-EVT in randomized controlled trials, and provide some basis for recommending this as a useful adjunct post-EVT in PAD patients. Objectives. This study aims to assess the efficacy of cilostazol as added therapy with antiplatelets after EVT in terms of decreasing restenosis, revascularization incidence, and incidence of bleeding and adverse effects. Methods. An electronic literature search for randomized controlled trials published up to June 2021 was conducted. Four randomized control trials which compared the efficacy of adding cilostazol to antiplatelet therapy in decreasing the risk of restenosis in patients with PAD who underwent EVT were selected. Data from all included studies were entered, compiled and analyzed using the Review Manager version 5.3 software. Results. A total of 589 patients from the four randomized controlled trials were analyzed in this meta-analysis. The efficacy of addition cilostazol post-EVT showed benefit of cilostazol in lowering restenosis (SMD 0.39 [95% CI 0.26, 0.57] P &lt; 0.00001), revascularization (SMD 0.44 [95% CI 0.30, 0.64] P &lt; 0.0001), and no significant differences between groups in preventing major cardiac cardiac events (SMD 0.80 [95% CI 0.51, 1.24] P=0.32) for post-EVT patients occurrence for post-EVT patients. Conclusion. The addition of Cilostazol to antiplatelet therapy post-EVT in patients with PAD may decrease rates of restenosis and revascularization. Keywords: cilostazol, EVT, restenosis, revascularization, major adverse cardiac events
Abstract 10259: A Case of Mitral Annulus Disjunction Highlighting a Disjunction in Our Knowledge
Authors: Anantha Sriharsha Madgula, Robert W Biederman
Journal: Circulation (2022)

A 56-year-old female patient was brought to our hospital after she suffered a witnessed cardiac arrest while flying on an airplane. She underwent bystander (in the aisle) CPR for about 20 minutes while forcing the plane to land. Altogether, she received seven shocks via AED. At the time of our evaluation, she was alert and in no distress. She did not carry a family history of SCD but reported “she had an issue with heart valve”. Her initial ECG showed atrial fibrillation with a heart rate of 135 bpm, QTc of 515 ms and no findings suggestive of myocardial injury. Her initial workup showed a potassium level of 3.2 mmol/L and no other significant laboratory abnormalities. Her TTE revealed thickened mitral valve leaflets with bileaflet prolapse and severe (4+) central MR. In addition, mitral annular disjunction (MAD) was noted. Her LVEF was 65% with normal wall motion. A left heart catheterization demonstrated normal coronary arteries. Following, a cardiac MRI confirmed MAD at the P3 scallop only, dilated mitral annulus and with a disjunction gap of 7 mm. Furthermore, there was no intramyocardial or annular late gadolinium enhancement (LGE) noted. An ICD was implanted for secondary prevention and she was then referred for mitral valve repair. With this case, we aim at increasing awareness of MAD and SCD. Currently, clinicians rely mostly on anecdotal evidence. While there is increasing literature suggesting the arrhythmogenic nature of MAD, the pathophysiology and implications are still debated. Interestingly, a subject of recent debate, our patient did not have any LGE suggesting no scar/fibrosis that would serve as a nidus for ventricular arrhythmias. Further, a threshold disjunction gap distance of clinical significance has yet to be determined. The benefit of surgical correction remains unclear. Indeed, further prospective studies are required to delineate MAD and help guide early management and its’ ultimate impact on prognosis
Abstract 10437: Venoarterial Extracorporeal Membrane Oxygenation Rescue Therapy in Vasoplegic Shock Due to Calcium Channel Blocker Overdose: 5 Year Single Center Experience
Authors: Ahmed Elkhapery, Hemanth Krishna Boppana, Saarwaani Vallabhajosyula, Anas Hashem, Hanan Malik, Cameron Hall
Journal: Circulation (2022)

Introduction: Over 15,000 incidences of Calcium Channel Blocker (CCB) overdose were reported by the American Association of Position Control Centers (AAPCC) in 2020, resulting in 45 deaths from pure CCB overdose and 176 deaths from multidrug overdose involving CCBs. We present a single-center experience on the use of VA ECMO in the management of refractory hypotension due to CCB toxicity. Hypothesis: VA ECMO is effective and can be life-saving in vasoplegic shock from drug overdose Methods: We retrospectively reviewed our ECMO registry in the last 5 years to identify patients who were started on ECMO support for refractory hypotension due to drug overdose. Results: We found 5 patients who were started on VA-ECMO for drug overdose, all involving CCBs. Mean age was 60. They had persistent lactic acidosis and hypotension after fluid resuscitation, requiring escalating doses of vasopressors until they were on or near the maximum. All patients were started on hyperinsulinemia euglycemic protocol and 3 patients received methylene blue. The mean time to intubation was 11.2 ± 4.14 hours. An echocardiogram demonstrated intact systolic function in all patients. VA-ECMO was started within 11.2 ± 4.5 hours of admission. Pressor requirements quickly improved on ECMO support. Average time on ECMO was 69 ± 48.6 hours. 4 of 5 patients improved quickly and were extubated within 10 days (mean: 4.88 ± 2.95). In these 4 patients, the length of ICU stay was 8.5 ± 3.87 days, and hospital stay was 11.75 ± 2.06 days. One patient had a protracted course due to renal failure, pneumonia, and concern for North-South Syndrome. Cannulation was switched to subclavian/axillary approach, but that was complicated by left arm ischemia and switch to VV-ECMO after 44 hours of VA-ECMO. She was discharged after a 46-day hospital stay. Conclusions: VA-ECMO support is effective and lifesaving in patients with refractory shock from CCB toxicity. Early referral to ECMO capable center should be considered in these patients.
Abstract 10201: Impact of Crohn’s Disease on Mortality and Outcomes in Hospitalized Patients Presenting With Non- St-segment Elevation Myocardial Infarction
Authors: Olukayode Busari, Michael Fatuyi, Jeremy Oh, Emmanuel Akuna, Sudhanva Hegde
Journal: Circulation (2022)

Introduction: Crohn's disease is a systemic inflammatory disease with high levels of cytokines that can lead to endothelial damage and atherosclerotic disease. We sought to evaluate the association between Crohn’s disease and mortality in patients hospitalized with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI). Methods: Patients hospitalized for NSTEMI with and without Crohn’s disease between 2016 and 2018 were identified from the National Inpatient Sample. The primary outcome was all-cause mortality. The secondary outcomes were cardiac arrest, cardiogenic shock, acute respiratory failure, acute kidney injury, length of stay, and patient charge. A multivariable logistic regression analysis was used to adjust for in-hospital complications. A p-value of &lt;0.05 was considered significant. Results: A total of 1,398,309 hospitalized patients with NSTEMI were identified. Of those, 3,356 patients (0.24%) were found to have Crohn's disease. Overall, the mean age was similar (66.4 years vs 68.1 years) among Crohn’s vs non-Crohn's patients. Crohn’s patients had less male (54.4% vs 59.8%) and more Caucasians (84.4% vs 72.5%). The primary outcome did not di!er significantly between the two groups; the rate of mortality was 2.2% in Crohn’s patients and 3.4% patients without Crohn’s disease in hospitalized patients with NSTEMI (Adjusted odds ratio, 0.67; 95% confidence interval, 0.34 to 1.30; p = 0.236). There was no statistical difference between the two groups regarding cardiac arrest, cardiogenic shock, acute respiratory failure, acute kidney injury, length of stay, and patient charge. Conclusions: Patients with Crohn’s disease in the setting of NSTEMI did not have a di!erence in mortality or other clinical outcomes when compared with patients without Crohn’s disease. As with most observational studies, causality may not be confirmed due to potential residual confounding.
Abstract 10098: Assessment of a Rate Pressure Product Target During Stress Echocardiograms in Patients With Advanced Cirrhosis
Authors: Huseyin E Arman, Saad A Ali, Nathaniel Elsner, Susan Ofner, Xiaochun Li, Joseph Zenisek, Kyle Frick
Journal: Circulation (2022)

Introduction: Dobutamine and exercise stress echo are routinely performed on patients with advanced cirrhosis though have low sensitivity in this patient population, even when target heart rate is achieved. This is in part due to their unique cardiovascular physiology which is frequently marked by reduced peripheral vascular resistance with low blood pressure, impaired chronotropic response to stress, hyperdynamic left ventricular systolic function and elevated cardiac output. In the general population, achieving a rate pressure product (RPP), defined as peak systolic blood pressure multiplied by peak heart rate, &gt; 25,000 is typically considered a high level of stress and is an adequate workload to detect ischemia, however this has not been validated in patients with advanced cirrhosis. We aimed to assess the impact of achieving a RPP &gt; 25,000 on the ability of stress echo to detect obstructive coronary artery disease (CAD) in patients with advanced cirrhosis. Methods: We performed a case-control study on patients with advanced cirrhosis where 88 had and 97 did not have CAD based on invasive coronary angiography. A total of 159 patients (85.9%, 77 with CAD and 82 without) had dobutamine and 26 (14.1%, 11 with CAD and 15 without) had exercise as their stress modality. Continuous variables were compared by means of Wilcoxon Rank Sum test. Categorical variables were expressed as numbers and percentages and compared by means of chi-square and Fisher exact tests. Results: The average maximum RPP was 19,999 ± 4,969.4 with 32 patients (17.3%) achieving a RPP &gt; 25,000 (14 with and 18 without CAD, P = 0.63). The average percent of maximum predicted HR (MPHR) achieved was 86.7 ± 9.2% with 136 patients (73.5%) achieving &gt; 85% of MPHR. Achieving a maximum RPP &gt; 25,000 (OR 0.83, 95% CI 0.39 - 1.79, P = 0.63) or a MPHR &gt; 85% (OR 1.04, 95% CI 0.54 - 1.99, P = 0.92) did not improve the ability of stress echo to detect obstructive CAD. Conclusions: Achieving a maximum RPP &gt; 25,000 did not improve the ability of stress echo to detect obstructive CAD in patients with advanced cirrhosis.
Abstract 10145: Cardiovascular Disease Risk and Outcomes Among Veterans by Sexual Orientation
Authors: Carl G Streed, Meredith S Duncan, Kory R Heier, John O'Leary, Melissa Skanderson, Joseph L Goulet
Journal: Circulation (2022)

Introduction: Lesbian, gay, and bisexual (LGB) adults have CVD risk and outcome inequities compared to heterosexual peers. With upwards of 7 million sexual minority adults aged &gt;50 by 2030, assessing and addressing their cardiovascular health is critical for clinicians and public health practitioners. However, few electronic health record (EHR) cohorts have been used to study this association. Methods and Results: In this analysis, we used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender EHR cohort, excluding transgender individuals to avoid conflating sexual orientation with gender identity. The baseline date was the first primary care appointment on or after October 1, 2009. Sexual orientation of 1,108,990 veterans was identified via a natural language processing tool with 88.2% sensitivity, 91.5% specificity, and 85.9% PPV; 185,788 veterans were classified as LGB. Prevalent CVD (history of AMI, ischemic stroke, or revascularization in the year preceding the baseline date) was present among 19,887 veterans (4,684 LGB). We calculated sample statistics stratified by sex and sexual minority status; results are displayed in the Table . We used logistic regression analyses to assess the association between sexual minority status and prevalent CVD. Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.12 [1.16, 1.24] times the odds of prevalent CVD compared to non-sexual minority veterans. Upon additional adjustment for BMI, diabetes, hypertension, lipids, substance use, anxiety, and depression, this association remained significant (OR [95% CI]: 1.08 [1.04, 1.12]). Conclusion: This is one of the first studies to examine cardiovascular health within a veteran population stratified by sexual orientation. Addressing the cardiovascular health of marginalized populations requires further exploring the mechanisms by which stress results in CVD risk and outcomes and the inequitable distribution of both.
Abstract 10114: A Systematic Review, Meta-Analysis of Sham and Placebo Controlled Trials Testing Spironolactone and Renal Denervation as Treatments for Resistant Hypertension
Authors: Mohammad Ahmed, Matthew Nudy, Rahul Bussa, Andrew Foy
Journal: Circulation (2022)

Introduction: The most common 4 th -line treatment for resistant hypertension (RHTN) is the addition of a mineralocorticoid receptor antagonist (MRA). Renal denervation (RD) has also been investigated as a treatment option for RHTN. A lack of data on the comparative effectiveness of these two therapies poses challenges in choosing optimal treatment strategies for patients with RHTN. Methods: Placebo-controlled and sham-controlled randomized clinical trials testing spironolactone or RD as treatments for RHTN were included in this analysis. Prespecified subgroup analyses comparing the efficacy of MRA and RD were conducted for the outcomes of 24-hour blood pressure (BP) and office BP. Results: Fourteen studies (8 MRA and 6 RD) were identified that included 2,306 participants (1,414 MRA and 892 RD). Cochran risk of bias assessment showed 84% of the domains to be low risk of bias for the MRA studies and 88% of the domains to be low risk of bias for the RD studies. The raw mean difference (RMD) between MRA and placebo control was statistically significant for 24-hour systolic (SBP) (-10.59 mmHg; 95% confidence interval (CI) -12.88 to -8.31), 24-hour diastolic (DBP) (-5.03 mmHg; 95% CI -6.75 to -3.32), office SBP (-10.43 mmHg; 95% CI -12.23 to -8.63), and office DBP (-4.10 mmHg; 95% CI -5.18 to -3.02). The RMD between RD and sham control was not statistically significant for 24-hour SBP (-1.85 mmHg; 95% CI -3.88 to 0.18), 24-hour DBP (-0.67 mmHg; 95% CI -1.84 to 0.51), office SBP (-1.93 mmHg; 95% CI -5.17 to 1.31), and office DBP (-1.55 mmHg; 95% CI -3.43 to 0.33). The interaction between the subgroups was statistically significant for all analyses. Discussion: MRAs had a greater reduction in 24-hour ambulatory and office BP compared to RD among patients with RHTN. This data may help physicians s counsel their patients regarding optimal treatment options for RHTN.
Abstract 10584: Nerve Growth Factor/Tropomyosin Receptor Kinase A Axis Plays a Pivotal Role in Breast Cancer Progression After Myocardial Infarction
Authors: Tetsuya Tani, Masayoshi Oikawa, Tomofumi Misaka, Takafumi Ishida, Yasuchika Takeishi
Journal: Circulation (2022)

Background: Several studies have shown that cancer incidence is increasing in patients with chronic heart failure. We have reported that nerve growth factor (NGF) plays a pivotal role in sympathetic nerve remodeling after myocardial infarction (MI). However, the impact of NGF on cancer progression in the setting of MI-induced heart failure remains to be elucidated. Methods and Results: NGF phosphorylated tropomyosin receptor kinase A (TrkA) in murine breast carcinoma 4T1 cells, and NGF increased the percentage of Ki-67 positive 4T1 cells. MI was induced by permanent ligation of the left anterior descending artery of female Balb/c mice. Then, 4T1 cells were injected into the right fourth mammary fat pad at two weeks after MI surgery. Serum levels of NGF were higher in the MI group than in the sham group at the time of 4T1 cell injection (279±107 pg/ml vs. 172±36 pg/ml, P=0.014). The size of breast cancer was significantly larger in the MI group than in the sham group at three weeks after 4T1 cell injection (451.8±137 mm 3 vs. 304.3±136 mm 3 , P=0.0014, figure). The percentage of Ki-67 positive cells in cancer tissue was higher in the MI group compared to the sham group (37.1±6.8% vs. 16.5±3.2%, P&lt;0.001). Furthermore, membranous TrkA was more phosphorylated in the MI group than in the sham group (1.56±0.11 AU vs. 1.00±0.11 AU, P&lt;0.001). Knockdown of TrkA with siRNA in 4T1 cells suppressed the increase of Ki-67 positive cells by NGF stimulation (51.9±1.2% vs. 24.9±3.7%, P=0.044). A TrkA inhibitor, GW441756, suppressed the NGF-induced phosphorylation of TrkA in 4T1 cells. Moreover, the percentage of Ki-67 positive cells in cancer tissue was lower in the MI mice treated with a TrkA inhibitor (10 mg/kg/week, I.P.) than in the MI mice without a TrkA inhibitor (26.3±3.6% vs. 45.6±3.7%, P&lt;0.001). Conclusion: Increased NGF caused by MI is associated with breast cancer progression through NGF/TrkA axis.
Abstract 10158: Initial Bilateral Pulmonary Artery Banding for Infants With Critical Left Heart Obstruction: A Multi-Institutional Analysis of Outcomes
Authors: Madison B Argo, David J Barron, Pirooz Eghtesady, Bahaaldin Alsoufi, Sergio A Carrillo, Osami Honjo, Adil Husain, Jeffrey P Jacobs, Anusha Jegatheeswaran, James K Kirklin, Linda M Lambert, Tharini Paramananthan, Maha Rahman, Karthik Ramakrishnan, Can Yerebakan, Mark E Galantowicz, Christopher A Caldarone, William M Decampli, Tara Karamlou, Jennifer Nelson, Jennifer C Romano, Joseph W Turek, Brian W McCrindle
Journal: Circulation (2022)

Introduction: The hybrid procedure (bilateral PA bands [PAB] ± ductal stent) is a contemporary management option for infants with critical left heart obstruction. We sought to determine patient/procedural characteristics, subsequent outcomes and associated factors after PAB in a multi-institutional study. Methods: From 2005-2019, 214 of 1236 infants from 24 Congenital Heart Surgeons’ Society participating institutions underwent PAB. Median follow-up was 7 years. Parametric hazard modeling with competing risk methodology was performed to determine risk and associated factors for end-states of biventricular repair (BVR), Fontan, transplantation (Tx) or death without an end-state. Results: PAB was performed at a median age of 7 days &amp; median weight of 3.1 kg. Intention of PAB varied - institutional preference (21%), non-cardiac comorbidities (20%), BVR consideration (12%), etc. Ductal stent was placed in 69% of patients (74% same day as PAB) and atrial septal interventions occurred in 61% (24% same day as PAB). Preoperative comorbidities (e.g. prematurity, genetic syndromes, neurological diagnoses, etc.) were present in 70%. At 5 years, 9% had reached BVR, 36% Fontan and 12% Tx (21/26 Tx immediately after PAB), with 35% having died and 8% alive without an end-state (Figure). Significant factors associated with BVR were presence of VSD and ductal stent; with Tx: earlier era, underlying aortic atresia, older age and greater weight at PAB, and absence of ductal stent; with death: low birth weight, ≥ moderate tricuspid valve regurgitation before PAB, &amp; older age at PAB. Conclusions: Heterogeneity is prevalent in patient/procedural characteristics and subsequent procedures and outcomes after PAB, possibly influenced by institutional preference and different intended management pathways. There is important mortality and &lt;50% of patients achieve a Fontan or BVR. Preoperative factors influence the use of this approach and thus are an important influence on outcomes.